Erika Carter
Gonzales,LA
Summary
Managed Care Contracting Specialist with 17 years of experience, adept at team leadership, strategic planning, and healthcare policies. Demonstrates expertise in medical billing, coding, and electronic medical record charting. Committed to leveraging skills in managed care contracting to drive innovative healthcare solutions and improve system efficiencies.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Managed Care Contracting Specialist
Refresh Mental Health
08.2022 - Current
- Coordinated 50+ contract processing activities monthly, ensuring 100% timely execution and compliance with regulatory standards
- Maintained the contract management system, validating $5M in revenue and accounts receivable valuations with 99% accuracy
- Interpreted and implemented managed care contracts, achieving a 98% accuracy rate in contract execution
- Reconciled 200+ processed claims to the EHR daily, ensuring 100% data integrity
- Managed data for 10 new acquisitions, enhancing operational efficiency and reducing processing time by 25%
- Optimized the contract management system, improving claims reconciliation efficiency by 30% and increasing accuracy in accounts receivable valuations by 20%
Senior Care Connector
AmeriHealth Caritas Louisiana
01.2019 - 08.2022
- Managed the distribution of daily work assignments, including worklist activities and fax queue management, ensuring timely completion and adherence to operational standards
- Compiled and analyzed reports for Performance Outcome Measures campaigns, manual outreach initiatives, and Healthcare Effectiveness Data and Information Set collection, contributing to data-driven decision-making for monthly departmental meetings
- Oversaw workforce management by adjusting schedules for optimal team performance and maintaining accurate records of attendance, paid time off, and leave requests
- Conducted quality assurance by auditing team member calls, providing constructive feedback, and coaching, enhancing customer service standards and team competency
UM Technician
AmeriHealth Caritas Louisiana
03.2015 - 01.2019
- Processed medical authorizations efficiently, ensuring timely and accurate decisions for those not requiring clinical review
- Delivered comprehensive support to healthcare providers, addressing inquiries and facilitating the authorization submission process
- Enhanced team capabilities by training new staff members and participating in the selection process for prospective employees
Account Advisor I
Capital Staffing/BCBSLA
08.2014 - 11.2014
- Advised 200+ members on health plans and coverage, addressing inquiries and providing clear information with a 95% satisfaction rate
- Educated 150+ members on benefits and coverage, enhancing their understanding and increasing member satisfaction by 20%
- Assisted 50+ providers with member eligibility and benefits, ensuring accurate authorization processes with a 98% accuracy rate
- Offered claims assistance, resolving 100+ issues for both members and providers efficiently, achieving a 90% resolution rate
- Supported additional tasks, contributing to overall team effectiveness and improving member satisfaction scores by 15%
Member Services Representative
Centene Corporation
10.2012 - 02.2014
- Advised members on insurance health plans across multiple states, ensuring accurate information
- Educated members on health plan benefits and coverage, enhancing understanding and satisfaction
- Assisted providers with member eligibility and benefits, facilitating smooth operations
- Resolved claims issues for both members and providers, improving service efficiency
- Updated member contact information, maintaining accurate records and communication
Customer Service Problem & Resolution Specialist II
Convergys
03.2006 - 05.2012
- Resolved customer inquiries regarding mobile phone billing, ensuring clarity and satisfaction with services provided
- Conducted training sessions for both new hires and existing staff on product updates and service offerings, facilitating consistent knowledge across the team
- Supported the successful implementation of new business lines and pilot programs, contributing to seamless rollouts and enhanced service capabilities
Education
Master's - Healthcare Administration
Southern New Hampshire University
Manchester, NH08.2021
Bachelor's - Business Administration
Southern New Hampshire University
Manchester, NH05.2018
Skills
- Team Leadership
- Administrative Support
- Strategic Planning
- Research & Development
- Microsoft Office
- Tableau
- Facets
- Medical Billing & Coding
- Medical Terminology
- Electronic Medical Record Charting
- Jiva
- Healthcare Policies and Proposals
- Innovative Problem Solver
- Teamwork
- Effective Communication
- Active Listening
Certification
- SHRM Certification
- AHIMA Certification
Timeline
Managed Care Contracting Specialist
Refresh Mental Health
08.2022 - Current
Senior Care Connector
AmeriHealth Caritas Louisiana
01.2019 - 08.2022
UM Technician
AmeriHealth Caritas Louisiana
03.2015 - 01.2019
Account Advisor I
Capital Staffing/BCBSLA
08.2014 - 11.2014
Member Services Representative
Centene Corporation
10.2012 - 02.2014
Customer Service Problem & Resolution Specialist II
Convergys
03.2006 - 05.2012
Master's - Healthcare Administration
Southern New Hampshire University
Bachelor's - Business Administration
Southern New Hampshire University
- SHRM Certification
- AHIMA Certification
Similar Profiles
Angelia CliftonAngelia Clifton
Billing Manager at Refresh Mental HealthBilling Manager at Refresh Mental Health
Kayla WatsonKayla Watson
Clinical Administrative Coordinator at Optum / Refresh Mental HealthClinical Administrative Coordinator at Optum / Refresh Mental Health
Patricia DelGavioPatricia DelGavio
Revenue Cycle Manager at REFRESH MENTAL HEALTH / OPTUMRevenue Cycle Manager at REFRESH MENTAL HEALTH / OPTUM